Pierce Mary Clyde, Bertocci Gina E, Janosky Janine E, Aguel Fernando, Deemer Ernest, Moreland Morey, Boal Danielle K B, Garcia Sylvia, Herr Sandra, Zuckerbraun Noel, Vogeley Eva
Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Pediatrics. 2005 Jun;115(6):1712-22. doi: 10.1542/peds.2004-0614.
Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP).
Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries.
Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types.
This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall-related femur fractures and identifies key characteristics to facilitate decision-making.
楼梯跌落事件在幼儿中很常见，在虐待儿童案件中也是常见的虚假病史。当儿童出现股骨骨折并伴有楼梯跌落病史时，必须做出合理性判断。缺乏客观的损伤和生物力学数据使得合理性判定更加困难。我们的目的是描述与报告的楼梯跌落导致的股骨骨折相关的关键特征，建立一个评估损伤合理性（IP）的模型。
对2至36个月大、因报告的楼梯跌落导致股骨骨折的儿童进行前瞻性研究。进行详细的病史记录、检查、骨折特征描述和损伤现场分析，并计算与损伤预测相关的生物力学指标。然后，使用我们提出的IP模型，对所有病例的病史细节、骨折形态特征的生物力学兼容性、就诊时间和其他损伤情况进行评分。
29名儿童被诊断为因报告的楼梯跌落导致股骨骨折。IP模型在两组之间做出了明确区分，分别为合理组和可疑组。在病史细节、骨折的生物力学兼容性、就诊时间、其他损伤情况和总IP评分方面观察到显著差异。在合理组中，与横断骨折相关的最小线性动量几乎是螺旋或青枝骨折类型的10倍。
本研究为当前关于儿童损伤生物力学和骨折的知识体系增添了新信息。IP模型提供了一种客观的方法来评估报告的与楼梯跌落相关的股骨骨折的合理性，并识别关键特征以促进决策。
